MEDICARE: TANYA TAEFI PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	63005	CA

General Provider Information

NPI Number	:	1063947216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA TAEFI PHARM.D.

Provider Business Mailing Address
First Line	:	6201 HOLLYWOOD BLVD STE 126
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5363
Country	:	US
Telephone Number	:	323-467-7954
Fax Number	:	323-284-7575

Provider Business Practice Location Address
First Line	:	6201 HOLLYWOOD BLVD STE 126
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-5363
Country	:	US
Telephone Number	:	323-467-7954
Fax Number	:	323-284-7575

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	04/25/2017

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